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Author Topic: To scooter or not to scooter?  (Read 13161 times)

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Offline SqshPlr8

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Re: To scooter or not to scooter?
« Reply #90 on: May 03, 2011, 10:21:12 PM »
R2D2 ordered a new MRI for my left (worse) knee.  He also looked at my old MRI and said that I could have a torn meniscus. Ultimately, he said that he could trim the fat pad and plica, but he didn't seem to be particularly enthusiastic about it ("it's a B+ surgery.")   He mentioned Scott Dye's neurosensory mapping experiment when he spoke of the the highly sensitive fat pad.  I'll get the MRI done in the next week.

I wasn't expecting much going into it.  The doctor was nice enough, addressing my questions about potential for cartilage damage and reservations regarding surgery.  Can't say I'm convinced a "clean-up" will help things out substantially.  But at least a new MRI might shed light on any unresolved issues.  Obviously, if I seriously consider surgery, I'll seek more opinions. Hopefully, I will get better in the meantime.  We'll see.

Offline knee always hurts

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Re: To scooter or not to scooter?
« Reply #91 on: May 05, 2011, 05:05:47 PM »
Wow, sounds really advanced. Just don't let the robots get into your brain. I repeat, never let them into your head! You should be alright otherwise.

I've come to the conclusion that most knee procedures are really "salvage" procedures, meaning that there is little guarantee as to the result. The procedure could be a total failure, or even make things worse. Or maybe, things improve dramatically. You just don't know. What I'd want to ask any surgeon is to delineate the relative risks. Why is it B+? Is it just that the results are unpredictable?

The good news as I see it is that knee surgeon is probably amongst the safest surgeries. Your chance of facing life threatening complications is exceedingly slim. The biggest risk is probably arthrofibrosis. At least in my case, I consider it well worth the risk at this point.

I called my doctor this morning and he said that he set up an MRI at the CRC! He is quite amazing. It'll be good to know that not only am I getting an MRI, but I'm getting one with the latest technology and one that is specifically calibrated for the knee. Hopefully I can finally get a diagnosis. I'm only half eager about getting this done, knowing that it is well past time to know, but also frightened by what it may show. I'm hoping I'll get the MRI done in the next couple of weeks, but the doctor should be getting back to me on the scheduling by later this afternoon. Let me know what shows up on your radiology report!

Offline SqshPlr8

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Re: To scooter or not to scooter?
« Reply #92 on: May 07, 2011, 03:20:54 AM »
Great to hear, KAH!  Let's hope for the best!

So advanced, I know...  B+? I know. One part: not all that predictable.  Second part: it's usually not just the soft tissue; something more complex is going on (Translated: "The heck do I know!"). 

I'll let you know about the radiology report.  I am having this one at a different facility (HSS now; Cornell the first time).  I'm curious to see if there is any cartilage damage to note as none showed up a year ago. (No contrast the first time; I don't know if I'm getting contrast this time) Maybe the past year of inflammation has chewed some stuff away.  Then again, MRI's, as we all know, aren't all that predictive of cartilage damage.  At some point I think I will need to get the other knee checked too.  I'm guessing there's at least an enormous suprapatellar plica there, though.

A part of me is guessing that there isn't going to be much or any damage.  I think I'm in a bizarrely nasty bout of soft tissue inflammation, that's it.  My synovium is a giant plica, my guess. 

Best of luck!




Offline knee always hurts

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Re: To scooter or not to scooter?
« Reply #93 on: May 07, 2011, 06:09:34 AM »
Are you leaning towards the surgery if the MRI results come back with something that the surgeon thinks they can treat? I know in my case, I was dead set against any surgery at first. But it weighs on you after a while. At some point, you start to think, if this has a decent chance of restoring some pain free, or even mostly pain free function, it's worth it. I would just really make sure I found out about how my prospective surgeon deals with arthrofibrosis. That seems to be the main complication of knee surgery. It may be less of a problem after an arthroscopic procedure, but still, the potential is there. I mentioned my concern to my aunt who has had multiple knee surgeries and was shocked to find out that she doesn't even have 90 degrees ROM in her operated knee! This is years later, so it isn't ever going to change. It sounds like, if it is treated correctly early on, most of these complications can be prevented.

http://www.kneeguru.co.uk/KNEEnotes/node/633

Offline SqshPlr8

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Re: To scooter or not to scooter?
« Reply #94 on: May 07, 2011, 06:58:27 AM »
Surgery is something I'm considering.  As you mentioned, I'm concerned about arthofibrosis  Honestly, it feels like have garbage under my patella.  Am I better than I was in the autumn? Of course.  But if I did anything resembling what I did during the summer, I would be just as bad if not significantly worse.  Then again, that I am no longer in constant pain is, relatively speaking, awesome.  So: Am I willing to risk arthrofibrosis or total pain in the hopes of restoring myself to more normal function?  Difficult question to answer at this moment.  Hopefully the new image will reveal something.  Maybe the radiologist will accept that plicas can be pathological and, therefore, of note (assuming that HSS's MRI-robots can visualize plicas).

If I could have a recovery like this person (she had plica + nasty, general synovitis), I would bow to our robot overlords. (A post taken from a runners site: http://www.runnersworld.com/community/forums/injury-prevention/injuries/re-plica-syndrom)


I got plica syndrome in 2005. It developed when I started running again after a pregnancy (bones and ligaments relax during pregnancy and continue to stay relaxed with breastfeeding).

Anyhoo. I was first diagnosed with "Runners Knee" (which is patellar subluxation irritating the cartilage) and advised to stop running by the Sports Med physician. I started cross-training with weights and biking and entered Physical Therapy. After about 2-3 months, it was just getting worse and worse, so I had them do an MRI. MRI showed torn mensicus, so I signed up for arthroscopy. Roll Eyes

During the procedure, the surgeon found my mensicus intact, however my plica tissue was inflammed and enlarged. He scraped out the portion that had been pinching between my leg bones and I rehabed from that for another 4 months. Rehab for arthroscopy is usually 6-8 weeks, but the plica was so inflammed that I had also developed synovitis (inflammation of the thin tissue lining of the knee joint).

Sooo. long story short, rehab made it worse. cross training made it worse. arthroscopy helped some. The key to complete recovery for me was this:

1. Rest completely for 2 weeks, followed by cross-training that ALSO rested the knee joint completely. I swam with my upper body and let my legs drag behind. I focused on upper body weight training to take my mind off running.
2. Anti-inflammatories - a heavy dose approved by my physician. In fact, I first tried Ibuprofen without success. I switched to Naprosyn and it worked like magic! After about 4 weeks of Naprosyn antiinflammatory treatment, we slowly cut back, then slowly added in running.

My case was pretty extreme - especially since the mis-diagnosis and biking and PT exacerbated it.

Offline knee always hurts

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Re: To scooter or not to scooter?
« Reply #95 on: May 08, 2011, 05:52:08 AM »
Funny thing is, the right knee with the junk under it has change quite a bit in the last few months. Last summer and fall, I couldn't even sit for more than a few minutes without the knee severely aching. That is no long the case, which is surprising. I guess that those sorts of things can improve in the long term. Yet, if I extend my knee, it still feels like bands of tissues snapping under there. I have a feeling that if I was to do a lot more, the pain is going to come right back. But that is a later concern. It's pretty cool that I can actually sit normally without a tremendous amount of pain now. It's not comfortable, but it's also not unbearable.

That does sound like an encouraging case. But you just don't know if you're going to be that person. It's always going to be a roll of the dice.

Hmm, I need to learn to read more carefully. I'm sorry, but for a second I had a big  ???  ???  ??? moment. I got lost somewhere at the breastfeeding part, imagining some alien species from Alderaan or something. Maybe you fled the planet before it got superlasered. I'm thinking, in what galaxy can a guy breastfeed! Then I'm like, oh, that's from that link he posted. Gosh, that was strange for a moment, though.   ;D

Offline SqshPlr8

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Re: To scooter or not to scooter?
« Reply #96 on: May 12, 2011, 08:53:37 PM »
Haha! Nope.  No breastfeeding...yet.

Just got a call from the doctor who took a look at my MRI.  He noted that my left knee has some scarring on the lateral side (I think over the LCL, but I am not sure, although I imagine this was a result of the original twisting of the knee last May where it "bowed out").  He also said that I do have a small tear in my MCL which he can't do much for.  He didn't note any cartilage damage or chondromalacia, which I know doesn't mean much, but at least my cartilage isn't so obliterated that it is easily visible by MRI.

In the end he recommended the scope: cleaning up the fat pad and plica.  I asked him if this was an unusual case, where everyday things were affected.  He said that that I was a pretty complex case, as he has mainly operated on "soft tissue" patients whose difficulties laid almost exclusively in the athletic realm.  I expressed my reservation regarding surgery given the ostensibly "hyperactive" nature of my tissue.  He said that he couldn't make any guarantees -- I may get worse -- but that I would more than likely get a decent dose of relief without that scarred up fat pad and plica. 

In closing I asked him if I risked any further damage if I were to give my knee another 3 to 6 months.  He said no, and suggested that I contact him after the summer.  And, I suppose, that's what I am going to do.

In the next couple months, I will solicit a few more opinions, and probably give another Paul Ingraham rest period a shot (lots of "motion-based rest," voltaren, etc.)  I might even bring back the old crutch to walk up to my fifth floor apartment.  I should get the actual report tomorrow. Let's see how things go.

Offline Stasha83

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Re: To scooter or not to scooter?
« Reply #97 on: May 13, 2011, 12:28:13 PM »
Hi there

I have been reading through your posts on and off for a while now but feel I should add my two pennys worth now. I had a surgery involving my fat pad last June. I now have Arthrofibrosis and a wrecked knee and will never make a full recovery. At the grand age of 27!

I think it may be worth you having a look at a few of my posts. They are not very well written but it may be helpful for you to see what it's been like for someone first hand as such.

I am sure I am just a very un-lucky case and most people would not encounter the complications that I have. Of course I do not want to put you off as it may well be the solution that you have been looking for.

Another thing I would add is that the fat pad is the most sensitive part of the knee. My physio told me a story about an OS who scoped his own knee without any anesthetic or pain relief. He prodded the meniscus, ligaments etc and felt no pain. He then prodded the fat pad and passed out due to the pain it caused. Mine certainly did not appreciate being operated on despite masses of pain relief!

I wish you the best of luck and hope that you make a great recovery.

Stasha
June 2010 - R knee TPF & Hoffa removal
Dec 2010 - R knee- Arthrofibrosis
Dec 2010 - L knee Myxoid degeneration of meniscus
Jan 2011 - R Knee 11 steroid injections & Synvisc1
Feb 11 - MUA & LOA
June 11- Steroid inj, EMG & nerve tests
Aug 11 - MUA & LOA
Feb 12 - R Knee denervation

Offline knee always hurts

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Re: To scooter or not to scooter?
« Reply #98 on: May 18, 2011, 12:27:29 AM »
I think that makes a lot of sense, given the potential for complications. Best to avoid surgery altogether whenever possible, I always say!

I think it's a bit uncertain as to how much inflammation is involved in something like an impinged plica. But to the extent there is any, it is almost certainly a very low level inflammation. I'd think that it would take years before it made much of an impact. It's good that you don't have any cartilage damage, at least that the MRI picked up. One thing you can do is to press your patella firmly while flexing and extending the knee. You should experience a distinctive grinding sensation, like there is sandpaper inside your knee if there is cartilage damage. If you don't feel that, then I'd say it's nice and smooth in there.

That being said, inflammation definitely does damage cartilage. As I've said before, I believe that's what happened to me. I was in agony for about a month, so that's when it happened I suspect. It's disconcerting when you realize that life is a physics simulation that only runs in one direction. We usually feel like everything is the same because of our body's regenerative capacity. When that doesn't happen though...

Your surgeon sounds decent. Let's hope you can work with him to figure out what the best course of action is.

Offline SqshPlr8

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Re: To scooter or not to scooter?
« Reply #99 on: May 20, 2011, 06:37:09 PM »
Stasha,

Thank you for your comments.  I read over your posts (which were detailed and well-written, by the way!). I was wondering how are you doing after your last surgery?  I have more detailed questions, but will ask them later.

KAH,

Thanks for the encouragement.  R2D2 seems like a reasonable guy, but I am going to consult with more patellofemoral docs -- perhaps even Dr. Dye -- and see what they think.   In the meantime, I'm going to give the voltaren gel and "crutch-up-the-stairs-routine" another shot.  Fortunately, I am in a better place now than I was in the summer/fall, so maybe it will help out to a greater extent.  That said, I am in the midst of a bit of a flare after digging holes in a park last Saturday. 

How are you doing?  Do you have a scheduled MRI and/or doctor appointments yet?  Have you been able to resume any more normal aspects of your life, even if you must use some form of help (e.g. crutch)?

Take it easy.

Sqsh

Below, I included the report.  Essentially what the doctor said, but I figured I'd throw out the "official" one.

Report (Left Knee MRI, no contrast)

The anterior and posterior cruciate ligaments are intact, as are the collateral ligaments and popliteus tendon insertion.  The proximal medial collateral ligament is moderately scarred thickened.

Evaluation of the menisci demonstrates no discrete medial or lateral meniscal tear.  The meniscocapsular junction of the posterior horn of the medial meniscus is mild to moderately scarred.

Cartilage over the medial and lateral femorotibial compartments is preserved.  There is no discrete chondral thickness defect over the trochlea or patella. 

The extensor mechanism is intact.  There is a trace amount of fluid within the joint, without an overt synovitis.  There is no fracture or osteonecrosis.  There is a trace amount of fluid within the deep infrapatellar bursa.

MRI of the left knee demonstrates a moderately scar thickened proxima medial collateral ligament.  There is no discrete meniscal tear, chondral defect or synovitis.  The meniscocapsular junction of the posterior horn of the medial meniscus is mild to moderately scarred.

Soo, scarred MCL and meniscus.  Bit of fluid.  I should be doing depth jumps in no time, right?















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